Chapter 054. Skin Manifestations of Internal Disease (Part 4) pdf
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Chapter 054. Skin Manifestations
of Internal Disease
(Part 4)
a
Most patients with trichotillomania, pressure-induced alopecia.
The most common causes of nonscarring alopecia include telogen
effluvium, androgenetic alopecia, alopecia areata, tinea capitis, and some cases of
traumatic alopecia (Table 54-5). In women with androgenetic alopecia, an
elevation in circulating levels of androgens may be seen as a result of ovarian or
adrenal gland dysfunction. When there are signs of virilization, such as a deepened
voice and enlarged clitoris, the possibility of an ovarian or adrenal gland tumor
should be considered.
Table 54-5 Nonscarring Alopecia (Primary Cutaneous Disorders)
Clinical
Characteristics
Pathogenes
is
Treatment
Telogen
effluvium
Diffuse
shedding of
normal
hairs
Follows either
major stress (high
fever, severe
infection) or change
in hormones (post
partum)
Reversible
without treatment
Stress
causes the
normally
asynchronous
growth cycles of
individual hairs to
become
synchronous;
therefore, large
numb
ers of
growing (anagen)
hairs
simultaneously
enter the dying
(telogen) phase
Observation;
discontinue any
drugs that have
alopecia as a side
effect; must exclude
underlying metabolic
causes, e.g.,
hypothyroidism,
hyperthyroidism
Androgeneti
c alopecia (mal
e
Miniaturizatio
n of hairs along the
Increased
sensitivity of
If no evidence
of hyperandrogen
pattern; female
pattern)
midline of the scalp
Recession of
the anterior scalp
line in men and
some women
affected hairs to
the effects of
testosterone
Increased
levels of
circulating
androgens (
ovarian
or adrenal source
in women)
state, then topical
minoxidil;
finasteride
a
; hair
transplant
Alopecia
areata
Well-
circumscribed,
circular areas of hair
loss, 2–
5 cm in
diameter
In extensive
cases, coalescence of
lesio
ns and/or
involvement of other
hair-
bearing surfaces
The
germinative zones
of the hair follicles
are surrounded by
T lymphocytes
Occasional
associated
diseases:
hyperthyroidism,
hypothyroidism,
Topical
anthralin;
intralesional
glucocorticoids;
topical contact
sensitizers
of the body
Pitting of the
nails
vitiligo, Down
syndrome
Tinea
Varies from
scaling with minimal
hair loss to discrete
patches with "black
dots" (broken hairs)
to boggy plaque with
pustules (kerion)
Invasion of
hairs by
dermatophytes,
most
commonly
Trichophyton
tonsurans
Oral
griseofulvin or
terbinafine plus 2.5%
selenium sulfide or
ketoconazole
shampoo; examine
family members
Traumatic
alopecia
b
Broken hairs
Irregular
outline
Traction
with curlers,
rubber bands,
braiding
Exposure to
hea
t or chemicals
(e.g., hair
straighteners)
Discontinuatio
n of offending hair
style or chemical
treatments;
trichotillomania may
require hair clipping
and observation of
shaved hairs or
biopsy for diagnosis,
Mechanical
pulling
(trichotillomania)
possibly fol
lowed by
psychotherapy
